Takeaways given performance, considerations of data limitations
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Statistics
All performance estimates are calculated as a percentage
95% confidence intervals are shown beside each estimate in brackets []
Confidence intervals(CIs) help us infer what true performance might look like with more data
CIs say “If we repeat the same data collection again 1,000 times, 95% of the results would fall in this interval.”
NEMSQA, what?
National EMS Quality Alliance
In 2014, NHTSA funded the EMS Compass Project (led by NASEMSO) to develop and test EMS performance measures. Uptake was limited, but it established key groundwork.
NHTSA and HRSA later supported the creation of the National EMS Quality Alliance (NEMSQA), initially facilitated by the American College of Emergency Physicians.
NEMSQA, what?
NEMSQA is now an independent, non-governmental organization serving as the national steward for EMS quality measures.
The Iowa Department of Health and Human Services recognizes NEMSQA’s foundational role in shaping EMS quality assessment.
NEMSQA Measures
A key feature of NEMSQA has to do with the creation of quality measures that can be thought of as national standards vetted by the community of practitioners versus a government entity.
NEMSQA Measures
NEMSQA uses a structured, lifecycle-based process to develop and maintain EMS quality measures.
Process ensures measures evolve with:
New clinical evidence
Changing system capabilities
Emerging stakeholder needs
Achievements
Here, we will review:
Airway-18 (Waveform Capnography Use for Airway Confirmation)
Asthma-01 (Beta Agonist Administration for Asthma)
Hypoglycemia-01 (Treatment of Symptomatic Hypoglycemia)
Safety-01 (Non-Use of Lights and Sirens During Response)
Achievements
Here, we will review:
Safety-02 (Non-Use of Lights and Sirens During Transport)
Trauma-01 (Pain Assessment in Trauma Patients)
Trauma-03 (Pain Reduction Achieved)
Airway-18
This process measure tracks the use of waveform capnography for confirming and monitoring advanced airway placement.
Asthma-01
This process measure monitors the administration of aerosolized beta agonists during EMS responses for patients diagnosed with asthma.
Hypoglycemia-01
This measure captures the percentage of patients with symptomatic hypoglycemia who receive corrective treatment.
Safety-01
This measure captures the percentage of EMS responses where lights and sirens were not used during the initial response phase.
Safety-02
Like Safety-01, this measure focuses on the transport phase, documenting cases in which lights and sirens were not used.
Trauma-01
This measure evaluates whether a pain assessment was completed for patients with injuries.
Trauma-03
An outcome measure that tracks whether a decrease in pain score occurred during EMS transport.
Gaps
Here, we will review:
Airway-01 (First-Attempt Advanced Airway Success)
Airway-05 (Preoxygenation Prior to Intubation)
Pediatrics-03b (Documentation of Weight for Weight-Based Medications)
Respiratory-01 (Assessment of Respiratory Distress)
Respiratory-02 (Oxygen Administration for Hypoxia)
Gaps
…in addition:
Safety-04 (Pediatric Restraint Use During Transport)
Seizure-02 (Benzodiazepine Administration for Status Epilepticus)
Stroke-01 (Stroke Assessment in Suspected Stroke Patients)
Syncope-01 (ECG Performed for Syncope)
Gaps
…along with:
Trauma-04 (Transport to a Trauma Center)
Trauma-08 (Trauma Vital Signs Documentation)
Trauma-14 (Pre-Arrival Trauma Alerts)
TTR-01 (Vital Signs for Non-Transported Patients)
TBI-01 (Documentation of Key Physiological Parameters)
Airway-01
This outcome measure assesses the percentage of EMS responses initiated through a 911 call in which advanced airway placement was successful on the first attempt without documented episodes of hypotension or hypoxia during the peri-intubation period.
Airway-05
This process measure evaluates the proportion of intubation procedures in which adequate oxygenation was achieved prior to airway insertion.
Pediatrics-03b
This measure focuses on the documentation of either actual weight in kilograms or length-based weight estimates for pediatric patients who receive weight-based medications.
Respiratory-01
This process measure evaluates whether EMS providers conducted a respiratory assessment for patients with a primary or secondary impression of respiratory distress.
Respiratory-02
This measure tracks oxygen administration for patients with documented hypoxia during EMS response.
Safety-04
This process measure tracks the use of appropriate pediatric restraint devices during EMS transport for patients under 8 years old.
Seizure-02
This process measure assesses the timely use of benzodiazepines in treating status epilepticus.
Stroke-01
This measure ensures that stroke assessments are performed during EMS encounters when stroke is suspected.
Syncope-01
This measure captures whether a 12-lead ECG was performed for patients presenting with syncope.
TBI-01
This measure requires the documentation of oxygen level, end-tidal CO₂ (ETCO₂), and systolic blood pressure during EMS transport of patients with suspected traumatic brain injury.
Trauma-04
This process measure assesses whether patients meeting CDC trauma triage criteria were transported to an appropriate trauma center.
Updated Trauma-04
Presently, NEMSQA is updating Trauma-04 to abandon using the eDisposition.23 field and instead leveraging eDisposition.01 or eDisposition.02 due to high variability in eDisposition.23.
Updated Trauma-04
Trauma-08
This measure evaluates whether the Glasgow Coma Scale (GCS), systolic blood pressure, and respiratory rate were documented in trauma patients.
Trauma-14
This measure tracks whether a pre-arrival trauma alert was activated for patients meeting field triage criteria (Steps 1 or 2).
TTR-01
This process measure evaluates whether a basic set of vital signs was documented for patients not transported by EMS.
Takeaways
Demonstrates national leadership in operational safety practices
Significant reduction in lights and sirens use during both response and transport
Leads peer states in waveform capnography adoption
Takeaways
Excels in clinical care performance
Strong results in asthma treatment and hypoglycemia management
Slightly exceeds national averages in trauma pain assessment
Evidence of a strong commitment to quality improvement across agencies
Takeaways
Key gaps in clinical performance:
Airway management, trauma triage, stroke care, seizure treatment, syncope evaluation
Persistent pediatric care and documentation deficiencies
Takeaways
Data completeness and accuracy remain limiting factors for system improvement
Many EMS professionals record critical details only in narratives, not in discrete data fields
Transitioning from narrative-heavy to structured documentation is essential for valid performance measurement
Strategic Priorities
Iowa’s proven record of progress positions it well for future EMS quality gains
Expand clinical education and simulation-based training
Reinforce standardized EMS protocols statewide
Address pediatric care disparities directly
Strategic Priorities
Iowa’s proven record of progress positions it well for future EMS quality gains
Improve EMS data quality: transition from narrative-heavy documentation to structured, discrete data fields for accurate performance measurement
Modernize and strengthen EMS data infrastructure
Analyses
At BEMTS, we have been hard at work creating open source software that benefits Iowans and other jurisdictions.
{nemsqar} package page
Questions?
Thanks!
Nicolas Foss, Ed.D., MS
Epidemiologist
Bureau of Emergency Medical and Trauma Services
Bureau of Health Statistics
Division of Public Health > Iowa HHS
C: 515.985.9627 || E: nicolas.foss at hhs.iowa.gov
